Dr Claire Gough
Research Fellow, ARIIA, Flinders University
‘Rehabilitation, reablement, and restorative care’ were recently identified as high-priority issues by the Australian aged care industry. It was therefore surprising that Australian rehabilitative aged care resources were difficult to find. An initial review of the literature suggested that agreement on a single definition of rehabilitation is problematic and perhaps a contributing factor. The Australian Government Department of Health has stated that medical rehabilitation ‘involves the diagnosis, assessment, and management of disability due to illness or injury.’ [1] This definition varies significantly from the World Health Organisation’s (WHO) definition of rehabilitation as a set of interventions ‘designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment.’ [2]
In discussing this difference with our Expert Advisory Group (EAG), the issue of defining rehabilitation was considered more significant than a simple variation in terminology. It was perceived by the EAG that the disparity was also evident between professional bodies and therefore healthcare professionals who often work together closely in aged care. For example, physiotherapists and occupational therapists consider that rehabilitation should include optimising function and reduction in disability for individuals with health conditions. However, the applicability of definitions was particularly unclear in the context of aged care settings across Australia.
A more pertinent issue for Australian aged care is perhaps that service users residing in the community were much more likely to receive rehabilitation than those living in residential aged care facilities. At present, Australian aged care focuses on terms such as ‘dependency’ and ‘deficit’ to justify funding. Yet these terms can act as a disincentive to embed the rehabilitative approach of ‘progression’ and ‘improvement’ into aged care services. [3] Despite the Australian Government providing funding and subsidies for restorative care and reablement services, rehabilitation is funded by the Australian health care system. The issue, therefore, lies in the Australian Government’s ‘Care and services in aged care homes guidelines’ which emphasizes that aged care providers cannot charge a resident for rehabilitation programs or assessments (Item 2.6 Rehabilitation support). [4] This has prompted much debate as to whether older adults residing in residential care services are entitled to receive rehabilitation following acute injuries such as a hip fracture, [5] or whether this is viewed as ‘double dipping’ from multiple funders.
Despite the issues around defining what rehabilitation entails across varied settings and the issues around access and funding, the call for rehabilitation to be expanded throughout aged care services in Australia continues [5]. Integrating rehabilitation throughout aged care services therefore requires deeper consideration, exploration, and involvement from providers, service users and aged care advocates to inform change.
*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.